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The Impact of Immigration on Public Health Systems


By Dr. Robert Carter
Faculty Member, Public Health at American Public University

As political conversations regarding healthcare reform in America linger, much attention has focused on how immigrants “negatively” impact our healthcare system. While media and some political figures use the term “immigrant” in a generalized context, there are several immigrant subgroups, including refugee and undocumented populations.

While there is significant opposition to immigration based in part on perceived healthcare utilization in certain groups, a recent article published in the Journal of General Internal Medicine suggested that undocumented immigrants provided a surplus of $35.1 billion to the Medicare Trust Fund between 2000 and 2011. The authors of this study challenged the notion that immigrants are a burden to the American health and public health systems.

The impact of immigration on public and healthcare systems is complex and not always easy to generalize. Differences among immigrant subgroups are significant and should be defined when discussing the impact of immigration on healthcare coverage and utilization. Nevertheless, significant research has shown that immigrants tend to have less health insurance, less utilization of traditional healthcare providers, and lower quality of care, with higher emergency room and urgent care clinic visitation when compared to U.S.-born populations. The question remains, “Why is so much of the healthcare reform discussion focused on the influx of immigrants into the United States?”

Generally speaking, immigrants are characterized as a vulnerable population and inadequate healthcare is a major factor in their status. While some political action groups tend to focus on civil liberties and the protection of “human rights” for immigrant populations, others are inclined to focus on the “excessive healthcare cost” and impact of “uninsured” patients on an already stressed healthcare system. Nevertheless, socioeconomic background, immigration status (i.e., refugee, documented, undocumented), English proficiency, residential location and marginalization are among the important factors that must be considered when examining the impact of immigration or uninsured populations on public health systems and personnel medical services.

Historically, immigrants come to the U.S. for career and employment opportunities and are relatively healthy with fewer negative health outcomes when compared to U.S.-born individuals. These are some of the reasons that contribute to fewer doctor visits and lower overall healthcare utilization. Interestingly, deterioration of health and more healthcare needs over time among immigrants may be related to adopting traditional Western diets and sedentary lifestyles.

However, poor access to care may be factors in particular among immigrants of lower socioeconomic status and poor English proficiency. These are among the top factors that contribute to greater need for personal medical and public health services. In a broader context, state and local health and hospital officials have focused on how to integrate and provide healthcare for undocumented immigrants into public health coverage programs and their use of hospital emergency rooms. To better understand how immigrants consume and affect the overall public health system, it is important to examine and consider each sub-population of immigrants from the perspective of their healthcare needs and availability coverage.

Much of the immigration data used in recent discussions of healthcare were analyzed many years ago, and more recent data suggests differences in medical care usage at older ages and with an aging immigrant and U.S.-born population there is a significant demand for quality healthcare. As long as this demand is high and it appears that quality is declining, we will continue to search for reasons such as the influx of immigrants as a mechanism for undesired changes in our public health programs and personal medical services.

Monitoring the health and well-being of immigrants is important for the overall health and public health systems in the United States. Additionally, we must continue to examine recent data on the healthcare needs of U.S.-born and foreign-born patients. It is very important for the public health system to maintain surge capacity and a robust perspective to ensure that personal healthcare services are available and of high quality.

Finally, we must educate ourselves about important topics such as healthcare and immigration to ensure that informed decisions are made to protect the public health system. I urge the readers of this blog to gain a better understanding of how immigration may impact their personal medical services and local public health system.

A good place to start is by visiting the following websites:


About the Author
Robert Carter Ph.D., MPH is an Associate Professor in the Public Health Program, School of Health Sciences, at American Public University.




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